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Get NH 4-H Leader Enrollment Form Program Year 20 County Your Last Name Mailing Address Phone # Fax #

Me Mailing Address MI Cell # Zip Code State Town Phone # Birthdate E-Mail Address Fax # Year as a 4-H Leader Actual Town where you live if not the same as your mailing address: Leader Type (choose one): Direct Leader (works with 4-H Youth) Organizational Leader (G) Gender: Indirect Leader (works behind scenes/ on committees) Project Leader (P) Resource Leader (R) Middle Manager (coordinates major 4-H Activity Leader (A) Residence: Farm Rural - Town under 10,000 Town/City 10,.

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